title: An exploration of context and the use of evidence-based nonpharmacological practices in emergency departments.
abstract: BACKGROUND
  The uptake of evidence in practice remains a challenge for healthcare professionals including nurses and providers. Increased use of evidence-based practices (EBPs) in healthcare settings may improve patient conditions such as pain and decrease the cost of health care. The relationship between context in the practice environment and uptake of EBP remains an understudied area.
  
  
  OBJECTIVE
  This study explored the relationships of context including the elements of individual, unit, and hospital and the use of evidence-based nonpharmacological pediatric pain management practices (EBNPPs) using an existing data set of RNs and providers, defined as doctors of medicine and osteopathy, nurse practitioners, and physician assistants caring for children in the emergency department.
  
  
  METHODS
  A secondary data analysis was conducted using correlation and regression.
  
  
  RESULTS
  Initial analysis identified several significant positive correlations with individual, unit, and hospital context elements and EBNPP. A significant correlation was not found between evaluation and EBNPP and magnet status and EBNPP for RNs or providers. RN regression analyses found that knowledge and continuing education were significant predictors of EBNPP. Overall context was a significant predictor of EBNPP for both the RN and provider models. A pooled regression analysis with RNs and providers found that RNs had a significant increased use of EBNPP when compared to providers.
  
  
  CONCLUSIONS
  Regression analyses found that overall context significantly predicted the use of EBPPM for RNs and providers although no one element-individual, unit, or hospital-was identified as more important. The effect of context on EBNPP did not differ by profession in this sample. Future research should focus on the overall influence of context on EBP and consider other factors that may play a role in the uptake of EBP.
authors.affiliation: Department of Nursing, University of Iowa.
authors.forename: Sarah J K
authors.initials: SJ
authors.lastname: Wente
authors.forename: Charmaine
authors.initials: C
authors.lastname: Kleiber
mesh_terms: D000328:Adult; D016208:Databases, Factual; D016529:Emergency Nursing / Q000379:methods* / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009722:Nurse Practitioners; D009741:Nursing Staff, Hospital; D015279:Organizational Culture; D010823:Physician Assistants; D011364:Professional Practice; D012044:Regression Analysis; D055815:Young Adult
keywords: context; emergency department; evidence-based practice; pediatrics; secondary analysis